Local Radiation Therapy to the Primary Bladder Tumor in Patients with Metastatic Urothelial Cancer - Expert Commentary

Systemic chemotherapy is the mainstay of treatment of metastatic bladder cancer. In a recent study, Fischer-Valuck et al. examined the role of local radiation therapy to the primary tumor in patients with metastatic bladder cancer treated with chemotherapy.

The investigators examined the National Cancer Data Base (NCDB) data. They identified 4,459 patients with metastatic bladder cancer from 2004 until 2015. To limit selection bias and other potentially confounding factors associated with retrospective studies, the researchers also performed sensitivity analyses besides the subgroup analyses. Patients who died or had no follow-up information were excluded. Landmark and matching analyses were performed to compare patients with longer survival times.

The investigators found that 7.6% of patients received a combination of radiation therapy and chemotherapy. The unadjusted median OS was 13.8 months for these patients compared to 8.4 months for patients receiving chemotherapy only (p<0.0001). Multivariable Cox proportional-hazards analyses revealed that the combination of chemotherapy and radiation therapy was independently associated with improved OS (adjusted for different variables such as comorbidities and demographics). The pattern of improved OS in the RT and CT patients persisted across subgroup comparisons.

These findings are in line with previous studies that have shown improved survival resulting from the local treatment of the primary tumor in genitourinary malignancies. However, extensive prospective validation of these results is needed in patients with metastatic bladder cancer.

Written by: Bishoy M. Faltas, MD, Director of Bladder Cancer Research, Englander Institute for Precision Medicine, Weill Cornell Medicine, New York City, New York


  1. B.W. Fischer-Valuck, S.A. Patel, R.J. Brenneman, et al., Association Between Local Radiation Therapy to the Primary Bladder Tumor and Overall Survival for Patients with Metastatic Urothelial Cancer Receiving Systemic Chemotherapy, Eur Urol Oncol, https://doi.org/10.1016/j.euo.2022.02.001.
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